Provider Demographics
NPI:1437268547
Name:MOODY, KRISTI HOLLAND (APRN, CPNP)
Entity Type:Individual
Prefix:MRS
First Name:KRISTI
Middle Name:HOLLAND
Last Name:MOODY
Suffix:
Gender:F
Credentials:APRN, CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30892 HIGHWAY 43
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:LA
Mailing Address - Zip Code:70711-2814
Mailing Address - Country:US
Mailing Address - Phone:225-567-2812
Mailing Address - Fax:985-543-0567
Practice Address - Street 1:42124 VETERANS AVE
Practice Address - Street 2:STE A
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70403-1427
Practice Address - Country:US
Practice Address - Phone:985-543-0565
Practice Address - Fax:985-543-0567
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2011-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP04909363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1344397Medicaid